Researchers call for national database of epidural complications

Complications are relatively rare but can be very serious, says 6-year study
Researchers have called for a national database to be set up to identify major complications arising from epidural pain relief after a small number of serious problems were identified during a six-year UK study, according to the April issue of Anaesthesia.

They discovered that 12 of the 8,100 people studied developed major complications after receiving epidural pain relief following an operation. Six developed epidural abscesses, three suffered from meningitis and three had blood clots in the epidural space.

Twelve different anaesthetists sited the epidural catheters and the patients were managed on five different wards after surgery. All the epidural insertions met recommended aseptic techniques to minimise infection.

“Although relatively rare, these complications are serious and point to the need for regular surveys to be carried out after epidural pain relief to identify risk factors and the scale of the problem” says consultant anaesthetist Dr Iain Christie from Derriford Hospital, Plymouth, UK.

“For example, epidural abscesses can cause neurological damage and paralysis of the lower limbs if left untreated.”

The survey which took place between 2000 and 2005 gathered information from four key sources.

Researchers looked at the hospital’s patient information system to identify patients undergoing surgery and the acute pain service to identify all patients receiving epidural pain relief after surgery.

They also looked at any patients who had received a spinal MRI scan or undergone relevant microbiological investigations within 60 days of surgery.

Before they carried out the survey clinicians were aware of seven patients who had suffered major complications after epidural pain relief during the study period. The survey identified a further five.

“Patients have a much better outcome if they are diagnosed and treated before neurological symptoms develop” stresses Dr Christie. “It is particularly important to monitor leg weakness – as this is an important measure of spinal cord health – and ensure that patient information systems pick up any infections following discharge from hospital.”

The authors point out that other reported cases of epidural abscesses following epidural pain relief indicate that it is not just a local problem.

“We would strongly recommend that all acute pain services supervising epidural pain relief after surgery perform a regular survey to identify patients who have suffered one of these complications” stresses Dr Christie.

“The results should then be stored in a national database to provide a more accurate estimate of the risk of these complications. This register might also identify other relevant risk factors such as MRSA infections.

“The Royal College of Anaesthetists carried out its 3rd National Anaesthesia Audit in September 2006 and says that it plans to report the findings in 2008. We hope that the outcome of this project will be a national register.”